# RED RIVER ARMY DEPOT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336340777
- **Authorized official:** DR. TROY ROSS M.D. (CHIEF MEDICAL OFFICER)
- **Authorized official phone:** (903) 334-2155

## Contact information

- **Practice address:** 9403 EVERGREEN DR, SHREVEPORT, LA 71118-3935
- **Practice address phone:** (318) 393-2243
- **Mailing address:** 9403 EVERGREEN DRIVE, SHREVEPORT, LA 71118
- **Mailing address phone:** (318) 393-2243

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171000000X | Military Health Care Provider | 13698 | OK | Yes |

## Other

- **Enumeration date:** 05/31/2007
- **Last updated:** 08/22/2020